In some parts of the country, but not in Cincinnati, a few companies are experimenting with rebates to employees who don't use all their health benefits in a year, says Paul Beckman, vice president of health care management for southern Ohio at Anthem Blue Cross and Blue Shield.

But Beckman hasn't seen clients asking insurers to set up health plans that charge differing rates to workers based on lifestyle factors.

More than 80 percent of U.S. companies with 50 or more workers promote good health by offering fitness centers, free health screenings, low-cost vaccinations, stop-smoking programs or other wellness services,according to the U.S. Department of Health and Human Services.

Companies with the most aggressive wellness programs are reaping benefits, according to government and industry sources. Johnson & Johnson, which includes locally based Ethicon Endo-Surgery, is one.

The company offers up to $500 a year in benefit credits for people who meet wellness goals related to smoking, exercising and controlling high blood pressure and cholesterol. Since the credits began in 1995, employee participation leaped from 26 percent to more than 90 percent.

At the same time, high blood pressure cases dropped from 10 percent to 1 percent. High cholesterol cases dropped from 66 percent to 43 percent.

The company calculates saving nearly $225 a year per employee in avoided hospital stays and reduced doctor visits.

Motorola, which employs 45,000 people in the United States, offers on-site fitness centers, health screenings, even aerobics for children. The company reports saving $6.5 million a year in reduced medical expenses for lifestyle-related illnesses such as obesity, high blood pressure and stress.

Even some public employers have begun promoting fitness more aggressively.

At Norwood City Schools, all school buildings and events went smoke-free in August 2003. At some buildings, red footprints painted on sidewalks mark mile-long walking paths. Teachers and staff get access to aerobics, yoga and kickboxing classes plus regular e-mails containing healthy recipes to cook at home, says Steve Collier, district superintendent.

For students, access to soda machines has been limited, and some pop has been replaced with water, fruit drinks and milk. Meanwhile, third- and sixth-graders in two schools get fresh fruit snacks every day as part of a nutrition program.

In Ohio, a new effort to promote corporate wellness programs is expected to begin this year.

Gov. Bob Taft's Healthy Ohioans Business Council is developing awards for healthy workplaces.

But some efforts to punish unhealthy behaviors may be illegal. For example, the Americans with Disabilities Act may protect obese people from discriminatory treatment, especially if they have thyroid problems or other conditions they can't control.